温肾法治疗高血压肾病  

Discussion About Treating Hypertensive Nephropathy with Warming Kidney Method

作　　者：林玮 王涛 黄奕 苏春丽 李军 LIN Wei;WANG Tao;HUANG Yi;SU Chun-li;LI Jun(Yunnan University of Chinese Medicine,Kunming,Yunnan,China,650500;The Third Affiliated Hospital of Yunnan University of Chinese Medicine,Kunming,Yunnan,China,650011)

机构地区：[1]云南中医药大学,云南昆明650500 [2]云南中医药大学第三附属医院,云南昆明650011

出　　处：《河南中医》2021年第12期1851-1855,共5页Henan Traditional Chinese Medicine

基　　金：云南省卫生科技计划项目(2016NS305);昆明市科技计划项目(2019-1-S-25318000001522);云南省教育厅科学研究基金项目(2021Y483);第四批全国中医(临床基础)优秀人才研修项目{国中医药人教发[2017]24号}。

摘　　要：李军教授认为,高血压肾病发病以上盛下虚为特点,在治疗肾病时亦应先分清标本虚实,关键在于下虚,补益下焦则可固下安上。将辨病与辨证相结合,治疗上时时注重顾护肾元,将温肾法运用于临床,常用金匮肾气丸加减治疗高血压肾病。李教授认为,患者出现微量白蛋白尿时肾脏损伤是可以逆转的,使用药物干预可延缓甚至避免向终末期肾衰竭进展。其治疗上主张温补肾气,在温肾的基础上结合患者上部水湿、血瘀较盛的情况,加减施治。李教授多用金匮肾气丸易桂枝、附子为益智仁、覆盆子加减治疗高血压肾病;使用温脾化湿之法治疗脾虚湿盛证,常用理中汤加减;常用葛根黄芩黄连汤或者四妙散加减治疗湿热证。Professor Li Jun believes that the onset of hypertensive nephropathy is characterized by upper excess and lower deficiency.In the treatment of nephropathy,we should first distinguish manifestation and root cause,deficiency and excess of samples.The treatment focuses on lower deficiency by tonifying the lower energizer so as to consolidate the lower and calm the upper.He often combines disease differentiation with syndrome differentiation,always pays attention to protecting primordial qi of the kidney,applies the method of warming kidney in clinical practice,and uses Modified Golden Cabinet′s Kidney Qi Pill to treat hypertensive nephropathy.Professor Li believes that the renal injury in patients with microalbuminuria can be reversed,and the use of drug intervention can delay or even avoid the progression to end-stage renal failure.He advocates warming and tonifying kidney qi.On the basis of warming the kidney,combined with the situation of water dampness and excessive blood stasis in the upper part of the patient,the treatment is properly given.He always treats hypertensive nephropathy with Modified Golden Cabinet′s Kidney Qi Pill by replacing Guizhi(Ramulus Cinnamomi)and Fuzi(Radix Aconiti Lateralis Preparata)with Yizhiren(Fructus Alpiniae Oxyphyllae)and Fupenzi(Fructus Rubi).In terms of spleen deficiency and dampness excess syndrome,he uses the method of warming the spleen and removing dampness,and adopts Modified Center-Regulating Decoction.As for dampness-heat syndrome,he often uses Pueraria and Scutellaria,and Coptis Decoction,or Modified Wonderfully Effective Four Powder.

关 键 词：高血压肾病 温肾法 李军 

分 类 号：R259.441[医药卫生—中西医结合]